Does The White House Have a Secret Strategy for Health Reform?

As Paul Krugman writes today, it's a bit tricky to say exactly what the White House's bottom line is on health care -- or even if it has one. "The only thing that's non-negotiable is success," Rahm Emmanuel likes to say. And a lot of things can be defined as success.

Krugman is concerned about the watered-down bill being considered by the Senate FInance Committee, and Obama's unwillingness to draw bright lines on what an acceptable piece of legislation looks like. There is a side of Obama, Krugman says, that "searches for common ground where none exists, and whose negotiations with himself lead to policies that are far too weak." This may well be right. The problem is that we don't know what Barack Obama is thinking.

Health reform, remember, is a long game. The Senate Finance Committee will not write the health reform bill. They will just write their version of it. Then it will merge with the HELP Committee's version. Then it will be amended on the floor of the Senate. Then it will be merged with the House's health reform bill in a process called "conference committee." Then that bill will return for a final vote.

So here's a question that few have asked, and that virtually no one knows the answer to: How important is conference committee to the way the White House is looking at health care? I've heard it's pretty important. Heard the same thing about Harry Reid, actually. If that's true, then this is what the Democratic leadership is thinking: The overriding imperative right now is to keep health reform alive. That's all that matters. Get it out of the Finance Committee. Get it off the Senate floor. If it's cut down to half a loaf, fine. You don't fix it now. You fix it in conference. Or you let Henry Waxman do it for you.

That, incidentally, is not an unprecedented strategy. It's what the Bush administration did with Medicare Part D. The expansion the Senate wrote was genuinely bipartisan: Ted Kennedy and Tom Daschle both voted for the legislation. But the version that came out of conference committee was significantly more conservative. Kennedy and Daschle abandoned the bill. Democrats began organizing against legislation they had previously supported. It passed anyway.

It passed because it's hard to filibuster bills emerging from conference. You can't change them, for one thing. No amendments are allowed. Nor is there time for debate. You vote for the bill, you vote against the bill, or you filibuster the bill. Those are your options. Democrats are likely to walk out of conference committee with 60 senators in their party. Ben Nelson will not be able to ask to change this bit he doesn't like, and Evan Bayh will not be allowed to offer an amendment weakening that piece. They stand with the White House or against it. And it is, in the estimation of most observers I've talked to, hard to imagine them literally filibustering the final vote on health reform. The White House would torture them until they lost reelection. And if no Democrats are willing to filibuster, then the White House could lose as many as 10 of them and still pass the bill.

At his press conference this week, Obama snapped back at a question from Chuck Todd. “I know everybody here is on a 24-hour news cycle," he said. "I’m not.” He's also not on a partial legislative cycle. He wants to sign a bill in October. That's the goal. The bill the Senate Finance Committee writes in June matters only insofar as it affects the bill Obama gets in October. And there are scenarios in which it's very important for that final bill and scenarios in which it's not very important at all. The problem is we don't know which playbook the White House is working from.

Obviously we don't know what strategy will work best, but each of the bills that goes to conference will have some of the elements we all want in them -- so it's not like they have to make a half loaf larger. All the loaves (and maybe the fishes) will be there. It will be a matter of sorting through them, right? Those of you who know this stuff better than I should comment, but this seems like a good way to approach it. And I have always thought in the end it would be hard for even the bluest of the Dems to vote against all of health reform because they didn't like parts of it.

Their strategy is what it always is: a combination of blackmail and payoffs. To freshmen, they will say they will deny funds for reelection -- to more seasoned members they will try to give perks of all kinds. If you took Emanuel and Axelrod and put THEM in charge of foreign policy we would be in much much better shape, because their vicious tactics are more appropriate for national enemies. They undoubtedly have the personal scandal information developed by the Clintons for use against older members of the house and senate. A combination of intimidation and bribes is what will bring success to Emanuel. It always has.

Despite President Obama's belief that all he has to do to get what he wants is to wave his arms and issue a proclamation that's not how it works in the real world. Perhaps if he had spent more than 2 years in the Senate preparing to be President he would understand this. There is only one certainity with health care reform. The end product will look nothing like Obama thinks it will. That's called politics.

Ezra: Great post. You've answered a number of questions I've been wondering about -- thanks.

And I think you're right with respect to Krugman's column today: the administration seems to believe -- I'd say quite rightly -- that at this stage it's all about getting SOMETHING out of the Senate. The object is to avoid focusing at this very early juncture on various and sundry deal-breakers that would provide talisman around which opponents of reform can rally -- and gain enough momentum to stop the legislative process. My money's on the side with Rahm Emanuel.

The White House uses Chamber of Commerce language on health reform. It taped a private equity underwriter, Nancy-Ann DeParle, for the Health Czar slot.

The conference bill will grease the skids for employers to shed that pesky health insurance benefit. The employee/worker will soon pay for their health care coverage. Employer sponsored health insurance will go the way of the defined benefit pension plan.

The bill won't come close to covering everyone, between illegal immigrants and the chronically non-compliant. That leaves safety net providers with a burden for caring for the uncovered.

Good thing progressives are pushing hard for single payer, so when the Dems rewrite the bill in conference the Overton Window has been dragged left, and the bill is as close to the best policy as possible.

Oh Ezra. If you believe in a secret strategy, you must have gotten back into the Kool Aid. The President will have no political capital left by the time there's a health care vote. What with exec orders on preventative detention and all...

Dana Millbank had an interesting piece yesterday about a breakfast with Emanuel and a bunch of reporters. The most arresting feature of which was descriptions, in passing, of the vile table manners of Emanuel. The practice is for the person briefing the reporters to stop eating, rather than spew food all the while, eat with hands (described at the end) and so on. All that was not mentioned was nose picking. Why is all this important? The French kings used to hold levees in their bathrooms, at which courtiers were obliged to witness the evacuations of the monarch. This is that on a lesser scale. He is so on top of the world that he doesn't have to observe the basic niceties and manners of life around you!

Sure, there could actually be a secret strategy for healthcare reform that will strengthen once it goes through the conference commitee. Show me a politician that can be trusted and I will believe that.

Sometimes trying to give others hope in something that is just a fantasy is a form of abuse.

Who cares whether the GOP wants to filibuster it? Why do the Democrats see the mere threat of a filibuster to be an insurmountable obstacle? Let the GOP stand on the Senate floor and talk and talk and talk. Read a cookbook. Read the bible for all I care. The American people are behind a public option to the tune of 70%. I trust the Obama Admin.'s ability to present this issue in a way that will make the Republicans in the Senate look despicable.

Dems need to find some spine. Otherwise, I have a feeling that they're going to face some tough primary challenges come 2010: